Provider Demographics
NPI:1568225340
Name:WRIGHT, MARK KEVIN (BA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:KEVIN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 RIGGINS RD APT 311
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-2200
Mailing Address - Country:US
Mailing Address - Phone:229-886-0850
Mailing Address - Fax:
Practice Address - Street 1:325 JOHN KNOX RD BLDG A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4101
Practice Address - Country:US
Practice Address - Phone:229-886-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker